Cholesterol deniers or statin pushers — is there a middle ground?

Clogged Artery

Sarah Bosely, the health editor of The Guardian, recently published an opinion piece demonizing those who question the role of saturated fat and statins in causing or preventing heart disease.

The Guardian: Butter nonsense: the rise of the cholesterol deniers

To be honest, this was a heavily biased and uneducated piece. Rather than present an objective review of the arguments, she uses demeaning language and accusatory tones to make the case that the status quo must be right.

Unfortunately, that attempts to silence a healthy debate and ignores volumes of scientific data to suggest that the topics of cholesterol and statins are more complicated than the status quo would have us believe.

For starters, Ms. Boseley combines two different arguments under one convenient but incorrect umbrella. Whether saturated fats cause heart disease and whether reducing LDL with statins prevents heart disease are two different issues.

Secondly, the pathogenesis of cardiovascular disease is a complex process. It does not do it justice to say it is simply a disease of too much LDL, or to say it is simply a disease of too much sugar, or to say it is all about inflammation. Instead, it is a multifaceted problem that requires a multifaceted solution.

Apparently the media thinks we don’t want to hear about complexities and nuances. It thinks we want to hear about good and evil — to pit one side against the other — as if one side has to be unequivocally right or wrong, leaving no room for a middle ground.

To see a properly written and scientifically referenced article on how science does not support the role of saturated fat and heart disease, look at the well written summary by The Nutrition Coalition. Did Ms. Boseley consider any of these scientific papers in her opinion piece? Clearly not.

Plus, recent evidence from Virta Health has shown that a low-carb, high-fat (including saturated fat) diet can reverse diabetes with little to no impact on LDL cholesterol. Again, Ms. Boseley’s one-sided article made no reference to the paradigm changing studies showing that the status quo is not always right.

Ms. Boseley also fails to understand the quality and limitations of science. Observational data with weak associations cannot support a causative role. Yet medical guidelines rely heavily on this type of evidence to support their conclusions. Time and again, we have seen this type of data proven to be incorrect; this is likely going to be one of those examples yet again. This type of correction of mainstream views can only happen through an open debate airing varying viewpoints.

But, that introduces complexity and nuance, which we already determined the media does not like to consider (likely because it doesn’t get as many clicks or views).

As for statins, they have become the wonder drug of our generation. Yet, the data shows that for those without evidence of heart disease, we have to treat over 200 people for five years to prevent one heart attack, with no reduction in the risk of dying. Plus statins come with potential side effects of muscle aches and weakness, an increased risk of diabetes, and possibly increased risk of dementia in some.

Is this a wonder drug? It all depends on your perspective.

Yet at the same time, it is clear that statins have an effect. For those with heart disease, we need to treat 83 people for five years to save one life, and 39 for five years to prevent one heart attack. (Of note, these are predominately pharma sponsored trials with heavy conflicts of interest.) It may not be a dramatic effect, but it is an effect. Therefore, claiming statins are useless and have no role whatsoever is equally incorrect and short sighted.

They key is finding the right approach for each patient. That means avoiding all-or-nothing claims and understanding individual variation.

The key is continuing a healthy debate to better define the right scenario for drugs and when they should be avoided.

The key is demanding higher quality evidence that stands up to scrutiny, rather than basing decisions on decades of low-quality science and subsequent consensus opinions.

Ms. Boseley fell far short of these goals in her biased opinion piece. I hope we can all do better.

Thanks for reading,
Bret Scher, MD FACC

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13 comments

  1. June
    This journalist’s qualifications to opinion on this debate stem from her degree in...........English.
  2. Paul
    Good rebuttal, Dr Scher. Any chance Mrs Boseley saw it? I’d be interested in reading her counter rebuttal.
  3. Mandy
    Indeed Paul, I couldn't agree more. Its easy to print this kind of biased opinion, not quite so easy to defend it me thinks!
  4. 3 comments removed
  5. Mike NZ
    Alex, your loyalty is wonderful.
    If she was reporting on the science (and both sides) clearly she failed here. Why did she not include all the science?
    The Author is correct in pointing that out and you are sadly incorrect in your trashy adhoim in response.
    I have noticed that many reports for nutrition are written as research, (should read marketing research) as it's often funded by food companies, why not the same for science and Big Pharma?

    My wife's a consultant (30yrs) and says they have to be careful of research pushed at them, that's one reason physicians are wary of new things. (read sell more or new drugs).
    Was the author under guidance from a pharmaceutical company perhaps?

    How many PR pieces do we see in the print media written as an article?
    My sister writes the copy for her local Journos where she works.
    It looks like the work of the paper but the copy is hers, she was taught that at Uni.

    Do you know of a British Scientist John Yudkin?
    I read him in my teens in the 70's, (pity I didn't listen as I wouldn't have got fat later :-)
    The American Sugar company funded Harvard Professors to produce research showing Sugar wasn't the problem as Yudkin proposed but Fat.....

    So I am not surprised at the volume of cry's about fake news nowadays.
    Again Wonderful that you are loyal, But the writer was clear, she could have referred to ALL the science.....

    Reply: #12
  6. Susan
    Dear Bret, I am a DD loyal follower, plus a U.K. The Guardian suscriber. I have emailed this journalist, copying and pasting your comments. Ill let you all know if I get an answer.
  7. A Brown
    I had read the article in the Guardian and noted the inconsistencies in the article. There was no attempt at looking at the High Fat, Low Carb arguments or the arguments against statins. It was a surprisingly poor article and should have been an 'opinion' feature not a story. The Guardian is ripe for a rebuttal and you should make it.
  8. Laura
    I am diabetic so my doctor put me on statins and blood pressure meds -I had symptoms of neither. I had a reaction to the statins so I was put on a different brand- same thing. The cramps, weakness and all over muscle pains were awful. I took myself off the drugs. How can a med that is suppose to be helpful be so harmful. My Dr shuttered when I suggested KETO but I am doing it any way. (and looking for a new doctor)
  9. Judy
    Since starting the Keto/low carb diet my cholesterol level has gone from 5.6 to 7.2 my good Chloe stroll is up but my doctor has now talked me int going on statins. I am not happy about this the more I read about this drug the less happy I am. And I am now going to stop them and stick with the healthy eating
  10. Alex
    I would reply more fully but I see my original comment has been removed! I think that speaks volumes. I notice people complaining abut not including all the relevant information in Sarah Boseley's original article. I hope there aren't double standards at work here and there is some reason that I'm not aware of now, and which I will be informed of, for the removal of my comment (and two more apparently).
  11. Susan
    Dear Bret and all.
    Previously (above), I advised that since I am in the U.K. and a subscriber of the newspaper that this journalist works for, that I would send her Brets above article, and advise you all of her response. This is her email reply:

    "Dear Sue

    Thanks for this. I'm afraid I disagree with him - and so do all the doctors, nutritionists and scientists whose advice I value and who are leaders in their field - I have received many positive and indeed congratulatory emails from them. I note also that we have not had a single request for a correction to this piece. This is clearly a subject on which some people have strong and entrenched views but I don't share them."

  12. Carol
    It's sad isn't it. She doesn't even realize that the drug company Mafia pay her wages through advertising and even pay for the Drs education so the only way we can even have this conversation is through an independent platform such as this one. Thanks again Dr Scher and Diet Dr.
  13. Tammi
    I follow keto and I believe that LCHF principles can in fact do the job of reversing years of processed food abuses.

    However, I take exception with the anti-media, anti-journalism tone of this piece. The complexity and nuance of media is introduced via a wealth of different media sources and opinions. That is writer has reached the same conclusion that many scientists have done (hence the very presence of statins) -- a conclusion that is contrary to ours -- isn't because the writer or the scientists on which the article was based are "just doing it for the clicks."

    I'm in Germany. The "Lügenpresse" label -- now matched by Trump's outright attacks on media as "enemies of the people" -- doesn't create critical thinking. Sure, we need critical readers of health and nutrition news as well as critical and investigative science.

    But we can't move the conversation along by shouting down all contrary news views as simply "Lüngepresse" without contributing to less critical thinking and more mob behavior. Let's keep the
    complexity and nuance there too, please.

  14. Carol
    Everyone(especially journalists) should listen to Dr Diamond's brilliant Low Carb Houston2018 talk which is now on YouTube.....several times before putting pen to paper on this topic.

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